Living donor or deceased donor?

Every kidney that is transplanted is ‘second-hand’. It may be in the future that we will be able to grow brand-new kidneys that can be made-to-order but we are not there just yet! Similar to a second-hand car, the quality of the kidney that is transplanted is therefore variable.

A kidney that is from a living donor can be considered like a second-hand car that is bought from a registered car dealership – where you are guaranteed that it has been through all the checks and all the boxes are ticked. In general, you can be fairly sure that the car will work! Similarly, any living donor has been through an extensive check and the quality of the kidney has been tested as thoroughly as possible.

However, for a kidney coming from someone that has died (deceased donor) it is not possible for there to have been such a thorough assessment. Getting a deceased donor kidney is therefore like purchasing a car from a private seller! The car may look good, with just one careful female owner, but there is a higher risk that there is something fundamentally wrong with the car that doesn’t become apparent until you’ve bought it. With a deceased donor kidney clearly something catastrophic has happened to the person, such that they have died and therefore the kidney may be ‘injured’ before it comes to be transplanted. Increasingly deceased donors in the UK are older people or people who have had high blood pressure or diabetes. When it seems likely that the kidney will not work if it is transplanted, then it is declined. It is not always possible to tell how a kidney will perform however and sadly a tiny number of kidneys never work after they have been transplanted. Having said that the majority do work

In NI there are half a dozen people whose deceased donor kidney is still working over 40 years since transplantation

While some living donor kidneys may not work well, and many deceased donor kidneys work very well, overall living donor kidneys work better and last longer. People who receive a living donor kidney in general will live longer than those who have a kidney from a deceased donor. Part of the reason for this may be that people who are waiting for a deceased donor kidney spend more time on dialysis and therefore they are less healthy overall by the time they receive a transplant.

Obviously it is a big step to consider taking the offer of a kidney from a friend or loved one. While much can be said on this issue there are two general comments here:

A kidney will never be removed from someone unless the doctors are satisfied that the risks to them, in the short and long-term, are small. The risks are never zero but have to be acceptably low before a kidney will be taken from a living donor.

Often the person giving the kidney will actually benefit from the transplant too. This is especially true perhaps in a family setting, where the need for regular dialysis treatment can dominate family life, holidays and activity. It can also be true for a friend or more distant relation as well, when the transformation in health and life of the person transplanted brings its own reward. Giving a kidney can be transformational for the donor as well as the recipient!

In summary it is worth considering any potential living donor but deceased donor transplantation remains a very important and good option for those who do not have someone who can donate to them directly.